Authorization Representative II – BioPlus Specialty Pharmacy

Role Overview

• Reviews accuracy and completeness of prior authorization information requested
• ensures supporting documents are present and meet company set standards
• Assists with the completion of medical necessity documentation to expedite approvals
• ensures that appropriate follow up is performed
• Collaborates with other departments to assist in obtaining prior authorizations/appeals
• Document insurance company interactions and all prior authorization information in the system
• Reviews insurance denials and submits appeals as permitted by payor
• Contacts physician offices as needed to obtain demographic information or medical data

Requirements

• Requires a HS diploma or GED
• a minimum of 2 years of experience processing pharmacy prior authorizations
• a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines
• Certified Pharmacy Technician highly desired
• Specialty pharmacy experience highly preferred
• Medical terminology training is preferred
• Experience with Prior Authorizations, Denials and Appeals highly desired
• Associates in this role are expected to have strong oral, written and interpersonal communication skills
• problem-solving skills
• facilitation skills
• analytical skills

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources